Intrapulmonal dislocation of a totally implantable venous access device

Abstract

BACKGROUND: Totally implantable venous access devices are widely used for infusion of chemotherapy or parenteral nutrition. Device associated complications include technical operative problems, infections, paravasal infusions and catheter or punction chamber dislocation. CASE PRESENTATION: We present the case of a 49-year-old patient with the rare complication of a intrapulmonal catheter dislocation of a totally implantable venous access system. Treosulfane for chemotherapy of metastatic breast cancer was infused via the catheter causing instant coughing and dyspnoea which lead to the diagnosis of catheter dislocation. The intrapulmonal part of the catheter was removed under thoracoscopic control without further complications. CONCLUSION: Intrapulmonal catheter dislocation is a rare complication of a totally implantable venous access device which can not be avoided by any prophylactic measures. Therefore, the infusion system should be tested before each use and each new symptom, even when not obviously related to the catheter should be carefully documented and evaluated by expert physicians to avoid severe catheter-associated complications.

Percutaneous Removal of Intracardiac Retained Hemodialysis Catheter: A Rare Complication of a Commonly Used Procedure

“…3 Perforation of the caval vein and migration of the catheter tip into the lung or mediastinal structures have also been reported. 4 A catheter fragment in the heart may remain asymptomatic for years. 5 Our patient was asymptomatic and the fractured catheter and distal embolization only became apparent on a routine preoperative chest radiograph.…”

Delayed cardiac migration of totally implantable central venous access catheter

“…Perforation of caval vein and migration of the catheter tip into the lung or mediastinal structures has also been observed. [8] Different mechanisms that lead to fracture and migration of the catheter have been described and include shearing by the introducer needle during insertion, bolus infusion, body movements, weakening of the catheter tip and mechanical compression between clavicle and the first rib. [5,7] In the index case, catheter migration was spontaneous as no plausible cause can be asserted.…”